Why the study?
The relationship between anticoagulation efficacy and safety in obesity is complex, and patients at extremes of body weight were under-represented in randomized trials.
Do direct oral anticoagulants provide comparable efficacy and safety to vitamin-K antagonists in overweight and obese patients?
Do direct oral anticoagulants provide comparable efficacy and safety to vitamin-K antagonists in overweight and obese patients?
Direct oral anticoagulants are comparable to vitamin-K antagonists for thromboembolism management in obese patients without increasing bleeding risk.
INTRODUCTION: The relationship between anticoagulation efficacy and safety in obesity is complex and can vary between degrees of obesity and anticoagulant choice. Indeed, patients at extremes of body weight were under-represented in randomized trials. Additionally, the possibility of an 'obesity paradox' has been raised in atrial fibrillation, describing decreased thromboembolic risk in obese patients. AREAS COVERED: We explore the current literature on anticoagulation in obesity, specifically with regard to efficacy in atrial fibrillation, efficacy in venous thromboembolism, and bleeding risk. Pharmacodynamic and pharmacokinetic considerations are also discussed. EXPERT OPINION: As a class, direct oral anticoagulants are comparable to vitamin-K antagonists in preventing and treating thromboembolism in overweight and obese patients, whilst not increasing bleeding risk.
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Salmon et al. (2025) conducted a review in Obesity with atrial fibrillation or venous thromboembolism. Direct oral anticoagulants vs. Vitamin-K antagonists was evaluated on Thromboembolism and bleeding risk.
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